February 24, 2008

Hillary is shaming Obama for telling people she's going to force them to buy insurance whether they can afford it or not. It really is so unfair. She's going to force them to buy insurance only if she thinks they can afford it. There will be tax credits and subsidies to get them to the level where they will be told they can afford it. Surely, no one will think they can't afford it once they government has figured out that they can. How dare Obama hinge his argument on the notion that people will have ideas of their own about how to spend their money.

59 comments:

Well he did take her bait rushing to a news conference and defending an attack mailer on health insurance, and a false NAFTA mailer on the same day he skipped out on the Black Union Forum that she herself attended.

How dare Obama hinge his argument on the notion that people will have ideas of their own about how to spend their money.

Yes, like with social security!

The mandate issue is a somewhat academic point, since it's highly unlikely that a fully mandatory system would survive congress, even a Democratic congress. Hillarycare came a cropper before with a Democratic congress after all. Taking that dispute seriously for the nonce, though, I'm not sure whether Krugman's points about Obama's plan here are correct or not, but if they are, Obama's plan is scarcely less idiotic than Clinton's.

I love it--Hillary is invoking Karl Rove--the democrats ought to move on and fight their own battles. And since HRC was co-president for 8 years, she needs to suck it up and take resposibility for NAFTA--or repudicate the President and Mr. Wiggly for supporting NAFTA. Pathetic.

I also don't agree with Penn Jillette with everything, but this raving by Hillary seems to show that he's spot on in your earlier post when he said

Don’t misunderstand me. I don’t agree with him [Obama] on anything, but he seems like a person that’s not about to just explode. And Hillary and McCain really seem that way to me. So that makes the election kind of fun.

Neither Clinton, nor Obama, nor a whole bunch of other folks understand the core problem of health care in America:

People expect first-dollar coverage by some third party.

That is simply unsustainable, and it dis-empowers health care consumers to the extent that only about 10% of health care expenditures are made by the recipient.

That's NUTS! What would auto insurance cost if we expected it to cover oil changes, new tires, and a brake job?

My wife and I have quite modest incomes -- we farm for a living -- but our medical insurance costs us only $116 a month. If we had kids at home, $128. How so? Because it's a $10,000 deductible, so we can avoid being wiped out by an accident, cancer, or some other major medical catastrophe.

We have friends our age paying $900 per month, and their company pays more, but it's a (really stupid) $100 deductible. The extra $800 a month almost covers our entire deductible in one year. That's crazy. That's a poor choice.

Do we really want the government to support us in such stupid choices? Apparently yes, or so hope the Democrats. In fact, Democrats believe no one should have more than $1000 deductible, but should have to pay premiums for that difference instead of having to manage our personal finances halfway decently.

I'm 59 years old, and I dread the thought that in six years I might be forced into Medicare. My current insurance is both better and cheaper, and I'd way rather keep it than have Medicare.

Under Medicare, if I want to make a private cash payment agreement with my doctor for a better price (s)he will be blackballed by Medicare for the next ten years, all claims being refused.

As a dual citizen I lived under the Canadian health care system for over 20 years. You do not, repeat, do NOT, want to go anywhere near such a system.

Politicians wishing to impose such a thing are far more interested in their own power than your well-being.

You are absolutely correct. Anecdotally, I have seen many blog posts and blog commenters lament the absence of national health insurance because they have to reach in their own pocket to pay for even a small deductible or co-pay.

I favor a GOVT voucher system- you choose an expensive plan (like your friends did) or an inexpensive plan (like you did) and the voucher is a fixed value NO MATTER WHAT PLAN YOU CHOOSE. If you pick the expensive plan, you pay the difference out of your own pocket.

Neither Clinton, nor Obama, nor a whole bunch of other folks understand the core problem of health care in America:

People expect first-dollar coverage by some third party.

I don't think so bart. The cheapest health insurance option at work is the health maintenance organization; the most expensive is traditional 80/20 insurance. Providing low cost office visits and cheap generic drugs prevents most of the catastrophic health care problems you insure yourself against, much as inexpensive regular teeth cleanings prevent costly fillings, crowns, and root canals.

How's your blood pressure, anyways? While a heart attack might kill you quickly, reducing the burden on your fellow insurance payers, a good stroke would put you in a nursing home for years, causing your wife to lose the farm before you're housed at taxpayer expense.

...Obama questions the existence of free riders. "I believe the reason people don't have health care isn't because no one's forced them to buy it", he said this month. "It's because no one's made it affordable".

My comment is perhaps Senator Obama can also make Rolls Royces more affordable. I always wanted to have one of those babies!

...Obama questions the existence of free riders. "I believe the reason people don't have health care isn't because no one's forced them to buy it", he said this month. "It's because no one's made it affordable".

My comment is perhaps Senator Obama can also make Rolls Royces more affordable. I always wanted to have one of those babies!

Excellent point that government has already addressed our transportation needs. My city has placed a fleet of chauffeur-driven $300,000 vehicles at my disposal. They will take me within walking distance of anywhere I want to go. Yet my co-pay for using them is less than $2.

While a heart attack might kill you quickly, reducing the burden on your fellow insurance payers, a good stroke would put you in a nursing home for years, causing your wife to lose the farm before you're housed at taxpayer expense.

Does that mean the government should provide us all with long term care insurance and disability insurance, too?

FLS: do you think it should be a company's responsibility, or the government's responsibility what my blood pressure is?

It's my responsibility and no-one else's. I've lived in a manner that my blood pressure is 102/60 and I weigh the same as I did when a college athlete. I've never smoked, drink reasonably, exercise a lot, and eat properly.

That was, and is, a choice available not only to me but to anyone. For me to be forced into a government-mandated low-deductible "guaranteed issue" insurance scheme would externalise --i.e. foist off on me-- the significant cost of all those white-trash walruses who've refused to take even basic care of themselves.

As is so perpetually typical of one Democrat plan after another, their approach to health insurance will penalise people doing the right thing in order to reward people doing the wrong thing.

We have nearly arrived at the point in America where the parasites outnumber the producers -- the point at which de Tocqueville stated our very form of government would be in mortal jeopardy.

You do realize you just referred to many people as parasites. And I would bet that most of them are not intentionally being slackers, trying for a free ride on your back.

If you honestly think there are more people trying to glom off of others so they don't have to put in an honest effort than there are producers in this country, then you are about as far off in la-la land as people like FLS and Eli Blake.

How close we are depends on whether or not you include bureaucrats in that category, which I do.

And, no, we're not there yet, but the focus of the Democrat party for more than a generation has been to expand dependency, then demagogue voters with fear of loss if they vote for those horrible Republicans.

We have nearly arrived at the point in America where the parasites outnumber the producers

It depends how you define things, I think. E.g. the population of the US is about 300 million, and the civilian labour force appears to be about 152 million. But of course, that excludes our military, and probably a lot of non-bureaucratic workers too, like firemen and policemen and so on, people who could not reasonably be characterised as parasitic, at least at this stage of American development. The total population figure also includes small children, many millions of them, who could not be expected to work either, because it is against the law. But they are also not allowed to vote, so I think that's a wash.

The BLS civilian noninstitutional population figure is only 232 million, giving a labour force participation rate of 65%. Not sure whether those figures include retirees and children, but since I don't think we have 70 million bureaucrats and incarcerated criminals, I'm guessing it doesn't. I'm also not sure that all those workers pay tax (e.g. does payroll tax kick in for part-time workers? Does the EITC cancel out payroll taxes?), but in general, someone who's working in the civilian world seems unlikely to be much of a parasite, all told.

Anyhow, the upshot of all that is I think we're rather far away from the parasite > worker tipping point.

Well, unless you're counting solely by taxes paid. In which case I, and probably everyone else posting here, am a leech on the body politick, since the fantastically wealthy pay for most of the junk we ask the government to do. We just free ride on them.

For me to be forced into a government-mandated low-deductible "guaranteed issue" insurance scheme would externalise --i.e. foist off on me-- the significant cost of all those white-trash walruses who've refused to take even basic care of themselves

Bart is absolutely correct!! A national mandatory health plan will just spread the risk so that the healthy and the young, who rarely need major medical, will be bearing the load (paying through the nose) to subsidize the unhealthy.

This is what insurance does.... spread the risk over the entire pool of insured. HOWEVER, nowhere in this plan do I hear about making those who have higher risk pay higher premiums. Just like car insurance or homeowners insurance, when you have differing premiums based on your driving history and locality to compensate for your higher chances of making claims. The way this pie in the sky health insurance is being proposed, there will be many who will not be receiving a benefit and paying for the others who will be getting the lions share of the benefits.

But I guess if your central ideology is "We are going to take things away from you for the common good" and other Communistic beliefs, then its perfectly fine to forcibly take from one segment of society to give to another. In "real life" this is ordinarily called robbery. But in Hillary and Obama's veiw point it is justified, comrades! YES WE CAN!

Garage: of course she can take credit for all of Bill and Mr. Wiggly's triumphs: Welfare reform, Nafta, Monica, etc--as to the President's role in gas prices: you may be unaware, but the price of gasoline has nothing to do with American policy--it is demand driven, and when the Indian and Chinese come on line as demanders of gasoline, it drives he price up--if you need an explanation of supply and demand, consult a basic economics text book.

If Hillary can't control her hubby, how in the hell is she going to control the presidency? You really can't be that stupid, can you?

Bart is absolutely correct!! A national mandatory health plan will just spread the risk so that the healthy and the young, who rarely need major medical, will be bearing the load (paying through the nose) to subsidize the unhealthy.

Guess what, you're already bearing the load! If you've noticed your premiums lately, it's not that hard to figure out actually. What happens to the young and healthy when they are not young and healthy anymore?

Depends on how they are classified as disabled. Are they disabled because they have created their own disability through the use of drugs, over eating to the point of weighing what 3 people should weight and other forms of self abuse? Or were they born disabled? Chronic alcoholism is classified as a disability for purposes of receiving SSI and Medicaid. People who are on permanent disability because they had a bad back incident at work, yet seem to be able to play baseball, golf and chop wood (I know these people personally) are parasites.

A handicapped to the point of not being productive person is not a parasite.

Depends again. There are plenty of handicapped people who are productive and contribute to society. Steven Hawkings and Stevie Wonder come to mind. Handicapped and unable to walk because you are a glutton...parasite.

You guys obviously have no idea how you sound, or don't care. Either way, it is pretty creepy.

No... I know how I sound and you are right: I don't care. We would all be better off if we had a little Darwinism in action on our society as a whole. Charity is for the truly handicapped and disabled, for children and animals. The government has NO business being involved in charity. But because it has been, we have created hordes of slacker, leeches and parasites who think nothing of getting a free ride on the backs of the productive.

What happens to the young and healthy when they are not young and healthy anymore?

They die?

Seriously. I have choices in my premiums that I would not have in a forced government program. I can, like Blake, wisely choose to have a high deductible coverage/catastrophic coverage for a low premium. I can pay out of pocket for the common cold or cut finger and invest or save the premiums that I didn't pay for coverage/insurance that I didn't need. I can also choose to roll the dice and have no coverage. If I lose it all to a heart attack, well then that was MY stupid decision then. Wasn't it? Why should you or anyone else pay for my stupidity?

Choice is the operative word. It seems that we have no choices in our own lives anymore and the government wants to make all of our personal decisions.

Why on earth does anyone expect the federal government to provide their healthcare "insurance", apart from whining about not being able to afford it oneself?

Our healthcare system is pretty damn good, and could be made better by LESS, rather than MORE government involvement.

Want costs to go down? Kick the feds and tort-chasers out of the system. Reform the insurance system so the insureds pay the full premium. Get rid of employer contributions. Post hospital and physician prices on the internet so buyers can shop around for prices. Let healthcare providers send out coupons, just like grocery stores do.

And while we're at it, change the policy coverages. I'm a 59 year old man married to a 60 year old woman. We don't need maternity coverage, and shouldn't have to pay for it. We're not drug or alchohol addicted, and aren't going to be any time soon, so why are we paying for that coverage?

Why does the state we live in mandate that all health insurance coverage include payment for acupuncture? Chiropractic? Cosmetic plastic surgery if it helps reduce a patient's "psychological" issues? All of these run up the cost of insurance. And don't get me started about infertility being classified as a disease whose treatment is covered by health insurance.

Does the government pay for renter's, homeowner's, life or automobile insurance? Nope, and they shouldn't. It's the same with health insurance. You need it, you buy it.

Or if you want DMV-style insurance, then keep crying for the feds to take someone else's hard-earned money to pay for your insurance. You'll get what the government is best at---lousy service at a high price.

Did you know that in eastern Canada in the last three months of 2006 there wasn't anesthesia provided for moms who were giving birth because the budgeted funds had already been spent?

Or how about having your MD tell you that he feels the same lump in your breast that you do, then waiting 5 months for a mammogram? And then another 4 months for a mastectomy if one is needed?

Did you know that are more MRI machines in Minnesota than in all of Canada? That's right. You wait up to 6 months for an MRI in Canada.

Of course, health care is free in Canada.

The government will always have a roll in treating the indigent, but why not sub-contract that to private providers?

But requiring all Americans to pay for a government-mandated health insurance program, with tens of thousands of pages of regulations, often created at the whim of political and bureaucratic whim? That's crazy. And the Dems want more of it.

You have to remember that the Clinton philosphy of government is your money is not yours, it is the government's. You are not responsible enough to invest the money you earn in a responsible and sensible manner, so the government will do it for you. it is their money, afterall. You only worked for it.

How is she going to enforce this? Steal our money by garnsishing wages? How is she going to fight all the lawsuits?

There is also a great deal of crypto-parasitism in our culture these days. I'll pick on farmers because I am one.

In a number of states, North Dakota and Montana to name just two, the amount of federal farm subsidies exceeds aggregate net farm income for the state. Federal subsidies cover not only all their "profit," but a chunk of their expenses as well. That is parasitism.

Many vegetable, cotton, alfalfa and rice farmers in California depend, utterly, on subsidised water. The most extreme example is one cotton grower who receives over a quarter billion dollars of water subsidy every year. Subsidised water use on alfalfa farms is so bad that you could pave the land with houses at 12 per acre and water use would drop by 60%. That is parasitism.

Thousands of organic and alternative farmers around the country receive generous subsidies to cover the cost of their "organic" certification, and many of them receive one federal grant after another for 'local food systems,' or 'grower development,' or 'value added' or 'marketing web sites.' THAT is parasitism.

The Alabama Peanut Queen festival receives a quarter million dollars a year in federal support. That is parasitism.

There are countless additional examples, believe me, and that's just in agriculture. In every single one of the cited cases the farmers have become dependent on their grants and subsidies. The didn't have to do; they chose the route of dependency. That, boys and girls, is parasitic.

"What happens to the young and healthy when they are not young and healthy anymore?"

In the US, if they have planned well and saved, or if they are on Medicare, they can avail themselves of our superb medical systems. In Canada, they can get the care they want if it is rationed for their age group; if not, or if the waiting list will outlive them, they come to the US or foreign medical centers to get it.

IOW, there is rationing in every medical care system--in Canada, the government controls the rationing, in the US the individual still has input. If you want to see how a (lefty) Canadian sees it, rent The Barbarian Invasions.

I saw the clip. The only person who should be ashamed of herself is Hillary Clinton. She continually denies substantiated accusations against her. She attacks instead of defends the positions she has held.

She is a hypocrite of the highest order and a liar. People actually support her? There must be something wrong with our educational system.

I agree with Bart and Michael H. and even DBQ but one must be politically practical. There is no stoppoing some form of universal hlth insurance so don't fight. Instead, pitch the most limited form possible (catastrophic or one like Bart and his wife buy) and make your case that it is sufficient, generous and appropriate for all. Then if someone wants more thay use their own money.

Re disabled people, DBQ, there will always be people that game any system (parasites) you could devise. The trick is to limit the numbers to as few as possible.

Oh, I can't resist, having lived in Quebec for 13 years. 'Invasions Barbares' (Denys Arcand, 2003) is unbelievably funny. I've never seen it in English, but Arcand's puns in French are absolutely side-splitting.

There's a great scene in which one of the protagonists (a bit power hungry) dies in the course of receiving a blow job. Given the quasi-Roman setting of the film, the follow-up: "Il voulut etre Cesar, mais il ne fut que Pompei." -- he wanted to be Caesar but was only Pompei (literally) -- is absolutely brilliant because in French 'pompe' [pumped] is common slang for BJ. In other words, he was power-hungry but all he got was a blow job.

His jabs at the health care system, declared unconstitutional by the Supreme Court of Canada, because its interminable delays violate the constitutional right to "security of the person," are also hilarious.

There is no stoppoing some form of universal hlth insurance so don't fight. Instead, pitch the most limited form possible (catastrophic or one like Bart and his wife buy) and make your case that it is sufficient, generous and appropriate for all. Then if someone wants more thay use their own money.

I agree that the coverage should be limited to catastrophic high deductible and a substantial copay, with provisions for wellness checkups (annual physical, innoculations for kids). Otherwise it is just free healthcare and we know how anything FREE is abused.

What about people who have pre existing conditions?

Are we going to deny them coverage as it is now in our private provider networks? Or do they get a free ride on the backs of the healthy.

Will those with pre existing conditions be paying higher premiums than the healthy?

Is this Universal Coverage going to make me pay for things that I will never need, like maternity? I've had that issue fixed for years. Literally.

Will the coverage and premiums be age based. Obviously the young people who are unlikely to have serious illnesses are going to get hosed... just like Social Security.

And what if I decide to give the government the big middle finger and have no coverage. Are they going to fine me... take away my birthday....put me in jail?

The bigger issue is our lack of control. When the Government is providing this care, they can also decide who doesn't get any medical procecures. Just look at what is happening in England. If you are a smoker or a big fat lard ass does this mean you should get less care? What if you have a genetic condition that you can pass to your children. Would the State be able to have you sterilized to avoid costly health care? Arlo Guthrie would have been in deep doo doo.

Who are the loudest voices on this issue? There are two groups : people like me and you who pay our own coverage and people who want more free stuff. There is a third group actually -the MSM and liberal pols.

IMHO, the "universal coverage" has to be catastrophic and open to all regardless of pre-existing conditions and should be community-rated so the risk and cost is pooled and spread across large numbers of people in an MSA.

As to annual physicals, etc that is none of the govt business. You are a bean-counter, there is no proof that it costs more to provide medical coverage to an unhealthy person vs. a healthy one. I am referring to lifetime medical costs- many studies have shown that on average 90% of your medical costs are incurred in the last six months of your life. Afterall we all die of something.

Indeed...he's undermining the entire raison d'etre of the Democratic Party.

People are, I think, seeing a false contrast between Clinton and Obama here. Clinton favours open mandates requiring everyone to buy healthcare. I.e. it's like social security -- it's a tax, and the government makes you pay it. Obama, theoretically, does not. But if Krugman's summary of his plan is correct -- and I grant that Krugman may simply be lying -- what his plan does is let you "not pay," and then, when you get sick, pay a reduced premium for "insurance." When your government created insurance pool is full of sick people, what do you do? Either you make the sick people pay a lot more -- something I have a difficult time imagining a Democratic administration doing -- or you bail out the system. With taxes. Our taxes. Or with debt. Our debt. So we pay for it all in the end after all.

Obama's system, as Krugman presents it, seems to me more or less like Clinton's in its bottom line effect on the population. It's just more effective at hiding the ball.

As to annual physicals, etc that is none of the govt business. You are a bean-counter, there is no proof that it costs more to provide medical coverage to an unhealthy person vs. a healthy one

The reason that insurance companies usually have coverage for "wellness" visits is that it is much easier to take control of a condition before it becomes an expensive and life threatening condition. For instance a person may be on the verge of developing diabetes that can be controlled with diet and exercise, preventing the development of worse conditions.

We have so many illegals coming into this country bringing wonderful diseases that we had thought stamped out or under control. Things like leprosy, tuberculosis, hepatitis and the ever popular AIDS. To have an annual physical included in insurance encourages people to get screened for these things.

Little diversion here. New jersey has more state debt per capita than almost every other state. Its governor, Jon Corzine, is on Fox right now discussing the federal budget. He says we must cut war spending so we can devote that money tp hlth care, college education etc.

I guess we could ask the governor if it was the cost of a war that got New Jersey in such a fiscal mess?

To an impartial observer, it appears the Hillary is carrying and extra 25 to 30 lbs. from the waist down. I think people would feel much better about the mandates that she is throwing around if her proposed health care legislation contained a section that mandated that she drop no less than 25 lbs. in six mo. from the effective date of her health care plan and that if she does not, the legislation lapses.

I had a glimpse of how healthcare will change when Wal-Mart opens walk-in clinics in every store. It gives and interesting comparison between how the private sector and the public sector look at the same problem - the economical provision of basic healthcare services.

I needed an eye exam performed by an optometrist in order to renew my driver's license. I went to the optometrist at the local Sam's Club. I got a very thorough eye exam for $43, about one-third what I paid for the same exam 6 years ago at the place where I bought my glasses.

The DO had a few minutes while my eyes were being dialated, so we chatted. He pays Sam's Club a small amount of rent for his exam room, paid for his optometry equipment, and has to maintain specific hours. He keeps the entire $43 per exam; Sam's Club sells glasses and contacts with their own employees in a nice area adjacent to the optometrist's exam room.

The DO said that he used to practice in as part of a larger group, charged $125 for an exam, and after paying his share of office rent and overhead costs, would net about $25 per exam. He charges less, but earns more at Sam's Club, probably makes about $125K annually. His wife, also an optometrist has the same arrangement at another Sam's Club.

Wal-Mart has nearly 1,500 optometrists in its stores, and is adding basic clinic services. Wal-Mart has hired a former Navy Admiral who was also in the department of HHS during Bush 43's first term. Wal-Mart is committed to creating its own healthcare system.

In southeast Wisconsin, where I live, Wal-Mart has announced that it will open walk-in clinics in 43 stores. Each location will be staffed by either a PA, Nurse Practitioner or GP. The clinics will be managed by the largest hospital system in the state; the clinics' computers will have access to all the system-wide patient medical records.

A patient visit costs $59, regardless of the reason. That's $59, regardless if the visit is for a few sutures for a cut, a physical, a UTI, the flu, a cold, etc.

The patient pays $20; Wal-Mart bills the insurance company $30. If the patient does not have insurance, the patient pays the full $59. If a prescription is written, it can be filled at Wal-Mart, often for only $4.

If the patient needs a higher level of care, an appointment is scheduled with the appropriate specialist.

The healthcare system that partnered with Wal-Mart benefits by having fewer patients use the ER as the source for primary care. Wal-Mart benefits by bringing more consumers into its stores. The consumer benefits by having easily accessible, low cost primary care.

It's simple, and it works. Of course, the politicians who believe we should live in a nanny state will step in at some point and screw up this efficient system.

I am so tired of this drivel. 1) There is no evidence to support it. I challenge you to provide some. 2) It makes no sense. One example, cancer. 25% of us will get cancer. You think this would drop to zero if we all had annual checkups and ate our Wheaties?